Towards Universal Health coverage

In Bangladesh, financing of healthcare is inequitable and inefficient…households remain the main source of financing for healthcare (out-of-pocket, OOP), comprising 64% of the Total Health Expenditure in 2007. This OOP  has been found the most inefficient and inequitable way to finance health care! In many cases these direct payments prevent access; in others they impose severe financial stress on people using services. They encourage inefficiency and inequity in the way available resources are used, by encouraging over-servicing for people who can pay, accompanied by under-servicing for people who cannot.

OOP is one of the major causes of household impoverishment…according to one estimate, about 4-5 million people are driven into poverty annually by catastrophic health expenditure (when expenditure on health is >10% of total household expenditure or ≥25% of non-food expenditure), and responsible for 22% of all shocks in the lives of the poor. Thus, some forms of pre-payment through insurance and other mechanisms (on the principle of ‘from each according to his ability, to each according to his need’) is urgently needed.

One way of achieving this is through Universal Health Coverage (UHC) for the population at large. UHC stipulates that “all people have access to essential health services without the financial hardship associated with payment” (Lancet 2010). The necessity of UHC have been emphasized in global forums again and again [e.g., WHA resolutions in 2008 and 2011, WH Reports in 2008 (PHC: now more than ever) and 2010 (Health financing), Commission on Social Determinants of Health 2008, First World Social Security Report 2010 etc.). Also, countries like India, Vietnam, Thailand, Ghana, Rwanda are marching ahead to the road of UHC since the beginning of the 21^st century. As the movement for UHC intensifies in other parts of the world, there is an imperative to prepare Bangladesh for it!

Bangladesh currently spends only US$ 16 per capita for health annually, a part of which comes from development partners. This is only 3.5% of GDP which is far behind other countries such as Nepal and Bhutan (≥4%). For embarking on the road to the UHC, innovative ways to mobilize internal resources are needed. These may include new taxes (earmarked and un-earmarked), diaspora bonds for the large number of overseas Bangladeshis, and (additional) excise tax on unhealthy products such as cigarettes, foodstuff and ingredients. Improving the negotiating capacity of MoH with MoF could yield positive results in terms of increased allocation for health in the national budget paving the way for quick transition to UHC. More importantly, with the rise in the country’s GDP, there more money should be available for health.

The Bangladesh Health Watch Report 2011, launched on 20^th February in BRAC Centre INN, Dhaka, in presence of the Health Minister, Finance Minister and the Nobel Laureate Amartya Sen, dealth with the these issues of UHC.  In this year’s report, several studies have been undertaken to investigate Bangladesh’s preparedness to achieve UHC within the foreseeable future, and identify opportunities as well as challenges which need to be overcome. The studies have looked at various demand and supply-side issues, the different models of health insurance, experiences of low and middle income countries in this regard and finally tried to curve a path for Bangladesh to move forward.